Provider Demographics
NPI:1114051653
Name:NORTHSTAR NEUROLOGY LLC
Entity Type:Organization
Organization Name:NORTHSTAR NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEOPOLDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DEALVARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-233-3850
Mailing Address - Street 1:PO BOX 81082
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-1082
Mailing Address - Country:US
Mailing Address - Phone:337-233-3850
Mailing Address - Fax:
Practice Address - Street 1:516 VEROT SCHOOL RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5026
Practice Address - Country:US
Practice Address - Phone:337-233-3850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty